Example

Page 1 of 6 

EEOICPA Dose Reconstruction Telephone Interview 

 Claimant is a Family Member 

As you may know, NIOSH is responsible for estimating the occupational radiation doses received by 

persons with cancer applying for compensation under the Energy Employees Occupational Illness 

Compensation Program. Our contractor, Oak Ridge Associated Universities (ORAU), will be 

conducting the interviews. 

This interview provides claimants with the opportunity to inform NIOSH of any additional information 

regarding the work history of the energy employee that might not be contained in the exposure 

monitoring information we receive from the Department of Energy (DOE) or Atomic Weapons 

Employer (AWE). While we encourage all claimants to participate in the interview process, 

participation is voluntary. Even though some claimants may not be able to answer all of the questions 

during the interview or have limited answers to the questions, any information provided during the 

interview may be useful in the dose reconstruction process. 

Interviews with survivors will seek more general information while the interviews with energy 

employees will contain more detailed questions. This interview should take no more than a half hour, 

although we may have to call you back for additional information. If we need to divide this interview 

into a couple of shorter calls, we can do that as well. While we believe that most dose reconstructions 

can be completed without discussing classified information, we will arrange for a secure interview for 

those claimants who believe such an arrangement is necessary to complete the interview. 
Example

Page 2 of 6 

Employment History

1. What jobs did ___{covered employee}___ hold, working for DOE, DOE contractors, or 

AWEs? 

Employer Supervisor’s 

Name

Job Title Start Date 

(mm/yyyy) 

End Date

FOR EACH JOB LISTED IN QUESTION 1, ANSWER THE FOLLOWING QUESTIONS. REPEAT THESE 

QUESTIONS FOR EACH DOE/AWE JOB INCLUDED IN THE EMPLOYMENT HISTORY. 

Detailed Work History:

2. How many hours per week did___{covered employee}___ work on this job? 

 ______hrs/week 

3. Do you know which buildings or locations (s)he worked in, routinely? 

Building/Location

4. Describe whatever you know about ___{Covered Employee’s}___ duties. 

________________________________________________________________________ 

________________________________________________________________________ 
Example

Page 3 of 6 

Radiation Monitoring

5. Did ___{Covered Employee}___ routinely wear radiation dosimetry badges? 

___Yes 

___No 

___Don’t know 

6. Did ___{Covered Employee}___ participate in a biological radiation monitoring program 

(urine/fecal/breath)? 

___Yes, urine 

___Yes, fecal 

___Yes, breath 

___No 

___Don’t know 

7. Do you have copies of ___{Covered Employee’s}___ dosimeter badge or biological 

monitoring records? 

___Yes, badge 

 ___Yes, biological 

___No 

IF “NO” GO TO QUESTION 8, IF “YES” :

7.1 Would you provide copies to us? ____Yes 

____No 

IF “YES” GO TO QUESTION 8, IF “NO” EXPLAIN THE IMPORTANCE OF THIS 

INFORMATION AND ADDRESS ANY CONCERNS, AS FEASIBLE. IF THE ANSWER REMAINS 

“NO”:

7.2 Why not? _________________________________________________________ 

8. Was ___{Covered Employee}___ ever restricted from the workplace or certain job duties 

because (s)he had reached a radiation dose limit? ___Yes 

 ___No 

___Don’t know 

Radiation Incidents

9. Was ___{Covered Employee}___ ever involved in an incident involving radiation 

exposure or contamination? 

___Yes 

___No 

___Don’t know 
Example

Page 4 of 6 

IF “NO” OR “DON’T KNOW” GO TO QUESTION 10, IF “YES” ASK THE FOLLOWING 

QUESTIONS FOR EACH INCIDENT IDENTIFIED:

9.1 What happened, and when?__________________________________________ 

9.2 Did ___{Covered Employee}___ receive chelation therapy or other medical 

treatment as a result of radiation exposure from this incident? 

___Yes 

___No 

___Don’t know 

IF “NO” OR “DON’T KNOW” GO TO QUESTION 9.4, IF “YES”: 

9.3 Please describe the medical treatment (s)he received: 

_____ Chelation Therapy 

_____________________________________________Other Medical Treatment 

9.4 Did ___{Covered Employee}___ receive biological monitoring after the incident? 

___Yes 

___No 

___Don’t know 

IF “NO” OR ‘DON’T KNOW” GO TO QUESTION 10, IF “YES”:

9.5 Do you have records of this monitoring? ___Yes 

___No 

IF “NO” GO TO QUESTION 10, IF “YES”:

9.4 Are you willing to provide copies of these records to NIOSH? 

___Yes 

___No 

IF “YES” GO TO QUESTION 10, IF “NO” EXPLAIN THE IMPORTANCE OF THIS 

INFORMATION AND ADDRESS ANY CONCERNS, AS FEASIBLE. IF THE ANSWER REMAINS 

NO: 

9.5 Why not?________________________________________ 
Example

Page 5 of 6 

Required medical screening x rays

10. Was ___{Covered Employee}___ ever required to have medical x rays for this job, as a 

condition of employment? 

___Yes 

___No 

___Don’t know 

IF “NO” GO TO QUESTION 11, IF “YES” :

10.1 Do you know how often (s)he was x-rayed, and over what time period(s)? 

Time Period Frequency of x rays

10.2 Do you have records of these x rays? ___Yes, for all x rays 

___Yes, for some x rays 

___No 

IF “NO” GO TO QUESTION 11, IF “YES”:

10.3 Would you provide us with copies of these records? ___Yes 

___No 

Other relevant information

11. Have we missed asking you about any conditions, situations, or practices that occurred 

during this job which you think may be useful to us in estimating ___{Covered 

Employee’s}___ radiation doses? 

___Yes 

___No 

IF “NO” GO TO QUESTION 13, IF “YES”:

12. Describe this with as much detail as possible, in terms of what occurred, where, when, for 

how long, and who was involved: 

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________ 
Example

Page 6 of 6 

13. Are you aware of any records related to the information you have provided that may help us 

estimate your doses? ___Yes: Source/Type

___Personal Physician 

___Site Medical Records 

______________________Other (describe) 

___No 

IF “NO” AND THIS IS THE LAST JOB TO REVIEW, GO TO QUESTION 14 

IF “YES” AND THE RECORDS ARE FROM A PERSONAL PHYSICIAN, ASK THE CLAIMANT TO 

OBTAIN AND PROVIDE THE RELEVANT MEDICAL RECORDS TO NIOSH.

Final Questions – Identifying co-workers and other witnesses

14. Can you name supervisors, co-workers or other potential witnesses, who can confirm or expand 

upon the information you have provided us? 

___Yes 

___No 

IF “YES” OBTAIN UP TO FIVE NAMES AND ANY CONTACT INFORMATION AVAILABLE:

1.____________________________ 

2.____________________________ 

3.____________________________ 

4.____________________________ 

5.____________________________